L iver transplantation is the treatment of choice for end-stage liver disease (ESLD), such as that from alcoholic cirrhosis or viral hepatitis. The demand for donor livers is increasing, outstripping the available supply and creating a long waiting list of patients with ESLD, many of whom die while on the waiting list. Increasingly, living donor liver transplantation (LDLT) is seen as a viable alternative to deceased donor liver transplantation to increase the supply of available donor livers. Studies of LDLT have shown acceptable results in terms of short-term survival and graft outcomes compared with deceased donor liver transplantation with full size organ (1) and long-term donor quality of life (2). In the nine-center adult-to-adult living donor liver transplantation cohort study (A2ALL), one-year graft survival was 81% (3) and most living donors maintained an above average health-related quality of life at 11 years postoperatively (4). In addition, recent advancements in surgical techniques and presurgical evaluation and preparation have continued to improve outcomes (5).LDLT is a major surgical undertaking. The healthy donor is subjected to a hemihepatectomy, a surgical procedure with significant risks, without apparent medical benefits to the donor. Studies have shown that living liver donors in the United States have a perioperative risk of mortality of 1.7 per 1000 donors (6), from causes including sepsis and acute liver failure. In addition, numerous other complications can occur after donation, including biliary leaks or stricture, and vascular thrombosis. Thus, careful evaluation and selection of the donors is mandatory to minimize the risks to the donors, as well as to maximize the benefits to the recipients. Preoperative imaging (computed tomography, CT; magnetic resonance imaging, MRI) plays a key role in the evaluation of donors by depicting biliary and hepatic vascular anatomy, liver volumetrics, and parenchymal disease, information that is key to safe LDLT. This review provides an overview of key surgical considerations in LDLT that the radiologists must be aware of, and imaging findings on CT and MRI that the radiologists must convey to the surgeons when evaluating potential donors for LDLT.
Types of LDLT and surgical considerationsThe three most commonly harvested grafts for LDLT are left lateral segment, left lobe, and right lobe grafts. The left lateral segment graft, which includes the Couinaud's segments II and III, is usually used for pediatric recipients or small size recipients. (LDLT) is increasingly used for the treatment of end-stage liver disease. The three most commonly harvested grafts for LDLT are left lateral segment, left lobe, and right lobe grafts. The left lateral segment graft, which includes Couinaud's segments II and III, is usually used for pediatric recipients or small size recipients. Most of the adult recipients need either a left or a right lobe graft. Whether a left or right lobe graft should be harvested from the donors depends on estimated graft and donor remnan...